Provider Demographics
NPI:1700468998
Name:KONG, ZACHARY (DC)
Entity Type:Individual
Prefix:DR
First Name:ZACHARY
Middle Name:
Last Name:KONG
Suffix:
Gender:M
Credentials:DC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 PINE RIDGE RD
Mailing Address - Street 2:
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34108-8909
Mailing Address - Country:US
Mailing Address - Phone:386-338-1881
Mailing Address - Fax:
Practice Address - Street 1:1000 IMMOKALEE RD STE 65&66
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34110-4803
Practice Address - Country:US
Practice Address - Phone:386-338-1881
Practice Address - Fax:386-338-1881
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-27
Last Update Date:2021-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL13510111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty